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Medical Student Examines Biases in Quest to Raise Awareness and Deliver Better Care

I came to medical school with a lot of guilt. My decision to attend Einstein, leaving behind a career as an elementary school special education teacher, made me feel selfish. I had abandoned my mission to participate in the education of my students in pursuit of my own future.

Doctor With Digital Tablet Talks To Woman In Hospital BedThis decision was even more loaded because I grew up in a white, middle-class family in a zip code with a quality public school district. My former students are predominantly black and/or Latino, living under the poverty line in a zip code with a failing, unaccredited public school and with the stigma of a special education diagnosis. But they are so much more than the stereotypes our society often attributes to them. They are brilliant, thoughtful, caring kids who deserve everything I had and more. But I’m scared they won’t get it.

Justifying My Decision to Attend Medical School
I could have been a part of ensuring that they received the education they deserved. I could have worked for them every day, and advocated for them. But I chose to stop. It is with that guilt that I came to medical school. Brené Brown, a noted scholar on vulnerability and shame, says that guilt is adaptive and differs from the destructive emotion of shame in that it allows us “to hold something we’ve done or failed to do up against who we want to be.” I just hope that’s correct.

I want to be someone who works to provide high-quality, compassionate, patient-centered care in low-income communities and communities of color. My passion and, yes, guilt drive me to do that, and I feel proud of that. So I’ve been grateful for every opportunity that Einstein offers to teach me how to become an empathic, mindful physician.

Disparities Elective Prompts Tough Personal Questions
One of those opportunities is an elective for first-year students called Health Disparities, taught by course leaders Drs. Cristina Gonzalez and Aaron Fox of Einstein and Montefiore Health System. The class is structured in two halves: the first on intraphysician causes of health disparities and the second on extraphysician or societal causes of health disparities.

The first part of the class forced me to examine my own unconscious biases and consider how those might affect my communication with patients or even what kinds of treatment or other options I offer them. As a self-proclaimed social justice advocate, I found it painful to acknowledge that I could perpetuate health disparities if I did not learn to recognize and manage my implicit biases in my future clinical career. But it feels really affirming to be given an opportunity to do this difficult, introspective work as a part of medical education. In the elective, I was assigned to take the Race Implicit Association Test, a highly validated measure of unconscious racial bias. I had taken the exam once before but still felt disappointed—though not surprised, given the society in which I live and the context in which I was raised—that the test determined that I have a “moderate” preference toward whites. With this information and a space within which to develop skills for management and recognition of bias, I feel more prepared to work to address my unconscious biases so I can deliver the same degree of care and compassion to all patients, regardless of race.

The second part of the class taught me the concrete skills of advocacy I had been yearning for: how to write an op-ed, how to speak to the media and how to lobby for policy change. It even empowered me to join Physicians for Reproductive Health at its lobby day in Albany this June to advocate for the addition of pregnancy as a qualifying condition for the New York state health exchange. I’m looking forward to hosting evening events—starting in September—as a co-leader of Medical Students for Choice to educate medical students on the topic of reproductive justice, especially because the Equal Access to Abortion Coverage in Health Insurance has recently been introduced to repeal the Hyde Amendment.

Turning Bias Recognition into Action
The physician-advocate-educators of the Health Disparities elective not only taught me critically important skills and concepts but also served as role models and reminded me that I am privileged to be a medical student and future physician, serving and advocating for incredibly deserving patients in underserved communities.

NOTE: Read a related release about the effectiveness of this health disparities course.

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Alyssa Liguori

Alyssa Liguori

Ms. Liguori is a second-year medical student in the track on urban community health at Albert Einstein College of Medicine. She is interested in social determinants of health, racial and ethnic health disparities, and sexual and reproductive health. She plans to pursue a career in family medicine.

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